FAST accuracy in major pelvic fractures for decision-making of abdominal exploration: Systematic review and meta-analysis

Chunlaches Chaijareenont; Chonlada Krutsri; Preeda Sumpritpradit; Pongsasit Singhatas; Tharin Thampongsa; Panuwat Lertsithichai; Pattawia Choikrua; Napaphat Poprom

doi:10.1016/j.amsu.2020.10.018

FAST accuracy in major pelvic fractures for decision-making of abdominal exploration: Systematic review and meta-analysis

Ann Med Surg (Lond). 2020 Oct 24:60:175-181. doi: 10.1016/j.amsu.2020.10.018. eCollection 2020 Dec.

Authors

Chunlaches Chaijareenont¹, Chonlada Krutsri², Preeda Sumpritpradit², Pongsasit Singhatas², Tharin Thampongsa², Panuwat Lertsithichai¹, Pattawia Choikrua³, Napaphat Poprom¹

Affiliations

¹ Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
² Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
³ Surgical Research Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Abstract

Background: Major pelvic fractures are often associated with intra-abdominal organ injuries. Considering patients' hemodynamic status, Focused Assessment with Sonography for Trauma (FAST) can facilitate decision-making for abdominal exploration. Non-therapeutic exploratory laparotomy from pelvic fractures should be avoided. Aim of this study is to determine the accuracy of FAST in diagnosing significant intraabdominal hemorrhage that leads to determine whether or not to pursue therapeutic abdominal exploration in patients with major pelvic fractures.

Material and methods: We systematically reviewed the PubMed and SCOPUS databases from 2009 to 2019 and also using a retrospective review of patients admitted to the Acute Care Surgery service from 2016 to 2019. We performed a meta-analysis by using a random effects model.

Results: A total 677 patients were analyzed, 28 cases from our hospital. Mean patient age was 40.8 years. Leading mechanism of injury were motor vehicle collision (44.72%), fall from height (13.41%), and motorcycle collision (13.69%). Average injury severity score (ISS) was 32.5 (range: 24.1-50), and overall mortality rate was 11.65%. The pooled sensitivity, specificity, and accuracy of FAST to identify significant intra-abdominal hemorrhage was 79%,90%, and 93%, respectively (95% confidence interval: 89%-94%). Meta-regression revealed no significant correlation between injury severity score and the accuracy of FAST.

Conclusion: Our meta-analysis revealed that FAST in major pelvic fracture accurately detected significant intra-abdominal hemorrhage. Using FAST in the presence of unstable hemodynamics, we can decide to perform abdominal exploration with the expectation of finding significant intra-abdominal hemorrhage require surgically control.

Keywords: Abdominal injury; FAST; Major pelvic fracture; Trauma; Unstable pelvic fracture.

Publication types

Review